Wednesday, August 20, 2008

-Robert Ouellet, incoming President of the Canadian Medical Association, and a big advocate of putting in a mixed system- using both public and private health care to improve access- in Canada; an idea that is surprisingly popular in the country.

The number one question I'm asked by Americans who know that I live in Canada is, "What's the health care like?"; even more so than questions about the weather or hockey. I am currently insured by my university in the United States, and Claire has an Ontario health card. Therefore, I have seen both the Canadian and US health care systems in action and here's the truth: they can both suck in different ways.

Don't get me wrong- both systems have their advantages; the problem is that advocates of private or public health care don't know how to take advantage of the benefits of the other system. As with so much else, it becomes an all-or-nothing argument, and the die hards don't know how to copy the good parts of the other system, so we end up suffering all the problems in order to maintain an idea.

We all know the problems in the US: all those people who are uninsured have to pay through the nose for health care. When Claire and her family hear about someone getting soaked for, say, a broken arm, they cringe. Personally, I've had ear drops that ended up costing me $250. My father, who is a self-employed lobsterman, pays as much for his health insurance as he does for all of his other expenses combined. He's a Reagan republican. He is also a big advocate of adopting a Canadian-style system in the US.

Secondly, it is absolutely false that having a private system increases your choices: if you have to use insurance, you're stuck with who the company will pay for. For instance, our school insurance allows me to see only three or four psychiatrists in our county, two of which seem to no longer practice! With public health care, Claire can go to any doctor in the country and not have to worry about the "list of approved providers", and for the record, there are just as many doctors up here as there are down there. It is much easier for her than it is for me.

Lastly, nearly everyone who has dealt with insurance companies has had some experiences in which the company refuses to pay for something for some nonsensical reason. It's heartbreaking to go bankrupt because you got sick; it's even worse when you actually have health insurance, but the company won't pay out. Every time the companies try to rip off a customer this way they dig their own grave a little deeper.

Okay, so let's get to burying public health care! For me, the most frustrating thing about Canadian health care can be illustrated by a story (that Claire can attest I repeat frequently!): a few years back, Claire was suffering from severe migraines; they run in her family, but the doctors wanted to be sure that they weren't caused by a tumor, so they wanted her to get an MRI, just in case. I expected that, sure, this would be taken care of within a week, so we wouldn't have to worry about her. She had to wait six weeks. For everyone else, this was okay- after all, she most likely didn't need the MRI. She was probably fine. They told me, correctly, that she would have gotten in quicker if the chances were higher that there was something there. I was livid.

The second problem can be illustrated by something I heard when I first came here that I thought was a joke: a doctor in Canada doesn't make much money at all. In fact, GPs start off making about as much as a good plumber. The result? They get trained in Canada and go to practice in the United States. Canada suffers from a serious drain of trained doctors and has been trying to make up the difference by luring over doctors from poorer countries. In my opinion, it's absurd to require people to go through that much schooling in order to get a job that doesn't allow them to pay the mortgage on a medium-sized house. It's also anti-intellectual.

Lastly, private funding is why the United States is so good at finding cures for illnesses: there's money in it. The downside, of course, is that American drug companies are also pretty good at inventing illnesses! But it was those "evil drug companies" that turned AIDS from a terminal illness to a chronic illness. And they're the ones that are going to perform miracles with stem-cell research. This will be the century of biology, just as the twentieth was the century of physics. And many of the innovations will come from the US, even if the doctors were born in Canada!

So, it seems to me that the US needs a bit less of the profit motive and Canada needs a bit more of it. In fact, Canada is already moving towards a mixed system that would include more private health care (the point of the article) while the US is moving towards a mixed system that would include more public health care. This is nothing to be afraid of. Our goal should not be to maintain the purity of an unsullied idea, but to get the best of both worlds.

1 comment:

Oh, thank you so MUCH for this article! Finally, after getting through tonnes of articles, admiring Canadian system, there is one to say the reality - it's not bad, but it's not wonderful too! As a Toronto life insurance broker I am selling also health insurance (it makes about 30% of health care expenses in Canada - for dentists and so...) and this discussion is getting deeper in these days. Imagine you want something, something what may say your life (MRI for example), you are willing to pay for it, but the system doesn't allow you to do it. Isn't it frustrating? If I should choose between being bankrupted and being dead, you know what I would choose. And not to say about doctors and their liberty to ask as much money for their work as they want...Lorne